In the early stages or phases of development, an experienced software developer (the current author, BLG), a mental health researcher (KMG), and practising clinical psychologists (JR and LP) collaborated to discuss the design constraints of the mobile app software that delivered an EMI for social anxiety. Design constraints were discussed and agreed upon to understand the overall health intervention aims of the EMI. Table 7 provides a summary of ideas for the EMI that were discussed among the mental health researchers and clinical psychologists but not implemented due to barriers that prevented implementation. These discussions also included identifying the boundaries of the problem domain and general requirements of the EMI. These design constraints were used to understand the underlying theoretical strategies underpinning the EMI.
Table 7. A summary of possible ideas for the EMI that were discussed but not implemented due to barriers.
Possible ideas for EMI Reasons for not implemented due to barriers
Using embedded sensors on a
smartphone to track behavior There was insufficient knowledge about the use of embedded sensors in smartphone, especially using them as part of an EMI for social anxiety. At the time of development, there were not many tools for developers and researchers to acquire these signals specifically for health interventions. The R&D team believed that the tools that were available required more testing, sufficient expertise and knowledge to configure, and sufficient time to invest in development. There were concerns on the battery consumption levels of the smartphone device when all sensors are active on the device, and privacy concerns with passive sensors (Hsieh et al., 2013).
Wireless wearable sensors to track physiological
measurements, such as sleep patterns
At the time of development, the R&D team were concerned with the validity of wearables. More research was required to invest in the use of wearables for a standalone EMI for social anxiety. There were particular concerns on issues relating to synchronizing wearables with smartphone or personal computer desktop systems.
Using smartwatches to deliver
EMI At the time of development, smartwatches were expensive. Additionally, the market for smartwatches was small and niche. The tools to develop apps for
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for developers and researchers. While this appeared attractive for the R&D team at the time, considerable time and investment in the technology was needed to conduct a sufficiently powered study.
Using existing gaming
technologies (such as Wii Fit) to encourage physical exercise for people with social anxiety or eating problems
The R&D team believed that gaming technology, such as Wii Fit, needed sufficient expert knowledge to configure the device to meet requirements of the EMI. Therefore, considerable time was needed to invest in the
development of the technology to deliver an appropriate EMI for social anxiety.
Using home monitoring cameras to measure the gait of people with anxiety and depression
Cameras installed at the home, work, or other
environments can measure the gait of people with social anxiety. This was feasible in smaller lab studies, however developing and implementing the technology for a sufficiently powered study was not feasible.
Using the embedded cameras of smartphone to capture and record photos and videos of a person social anxiety.
Use of embedded smartphone cameras was the most feasible solution to implement for an EMI for social anxiety. Given the limited knowledge of the smartphone app platform at the time of development, the R&D team decided to work on a stable system (using a basic
software architecture) before exploring the integration of embedded cameras. This design decision was made to reduce the risk of failing to deliver a functional EMI for the evaluation study.
The R&D team agreed upon some design constraints. First, the EMI must target the reduction of social anxiety symptoms (i.e., clinical aims of the EMI). Second, the content and structure of the EMI must be based on exposure therapy (i.e., the clinical strategy of the EMI), which is an evidence-based treatment for social anxiety (Craske et al., 2014). Third, the EMI must be a standalone health intervention (without therapist support). Forth, the iOS software platform must deliver the EMI on a native mobile app for Apple smartphone devices. Hence, this restricted the development of the EMI to a platform- specific mobile app framework.
During a period of 18 months, the development process continued to guide the development of the iOS mobile app software for the delivery of an EMI for social anxiety. Appendix G presents a timeline of each of the design phases. Sections 4.5.2 to 4.5.8 provide detailed discussions of the remaining design phases used to complete the EMI prototype. The appendices contain the relevant software artifacts produced at each design phase. These software artifacts and diagrams in the appendices provide the detail designs of the EMI through each of the conceptual design phases of the development process.
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Key learnings from phase 1
Phase 1 of the development process allowed space for all stakeholders of the R&D team, such as the software developer, mental health researcher, and clinical psychologists to brainstorm ideas and critically discuss the scope of the project. Many of the ideas discussed were difficult to implement because of technical and resource constraints of the project. An example of a technical constraint included validity issues of wearables, or financial constraints of purchasing expensive mobile devices, such as smartwatches. Phase 1 of the design process assisted the R&D team in narrowing the scope of the project and eliminating any uncertainty of the EMI design. Estimating the feasibility of ideas were difficult in phase 1 (i.e., time to develop) for the R&D team because there were a lot of uncertainties in ideas proposed by different stakeholders. For instance, the software developer with limited knowledge of psychotherapy could not determine the time needed to develop a particular EMI concept proposed by the clinician. Similarly, the researcher and clinical psychologist had limited knowledge of software development process to understand the technical proposals by the software developer. However, some general parameters were agreed upon, which include the technology platform, the support of the therapist, and the clinical strategy. In the subsequent phases of the design process, these parameters became the starting point to formulate and build on the design of the EMI through iterations.